Patient Portal/Appointment Request

Patient Portal For New and Follow Up Patients at JCCR

You no longer need to spend time filling out multiple forms in your physician's office. Joliet Center for Clinical Research ( JCCR ) Patient Portal enables you to provide your health information electronically at your convenience 24 hours a day, 7 days a week from the privacy of your own home, office or mobile device.

You may receive several different forms via email or through the Patient Portal for an upcoming appointment, or just as a follow-up. Your participation will enable us to evaluate our services so we can continually provide the best possible care to you and all of our patients.

New Patients:

What to Bring to Your Appointment If You are a New Patient at JCCR

Picture ID

Insurance card

List of prescription medications and dosages

Current contact information

Emergency contact information

Any and all relevant Psychiatric records such as office/hospital notes

If you are a New patient please fill out the form below.

Existing Patients:

To Sign In to your Patient Portal , schedule an appointment, request medication refills,pay on balances and communicate to your provider for existing patientsat our clinic:

Please Click on the Patient Potal Link to begin process of signing and/or creating a link into your Patient Portal with JCCR---->PATIENT PORTAL

On the Patient Portal, you will need to supply some personal information and the temporary password given to you by our office to complete the registration process.At the end of the account registration process, you will be asked to create your own password.
Password should:

Be between 6 to 15 characters

Contain at least 1 numeric and 1 special character

Patients participating in the patient portal can schedule an appointment, obtain records, request medication refills,pay on balances and communicate with your provider via a messaging link in the Portal.

Please do not share your credentials with anyone. Feel free to contact us at 815-729-7790 for any questions or concerns

Please do not leave Medication refills or request in form below. Please call 815-729-7790 ext 1 or request in patient portal for Medication refill or requests.

If you currently are in crisis or experiencing thoughts of suicide; thoughts of harm to self or others; unusual or erratic behavior or moods, please call 911 or go to your nearest hospital or Emergency Room immediately.Please be aware that there will be no one to take your call if it is after hours or a non-business day including Sat., Sun and holidays. Please allow one business day for a response to any message left for the office.

Patient Registration

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

Please don't put anything here:

Your Name:

Your Phone Number:

Your Email Address:

Preferred Date and Time:

Your Message:

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